tbuckley/cabot-search huggingface dataset:
Abstract 11404: Phenotyping Cardiac Sarcoidosis With PET/MR: Imaging Characteristics, Treatment Response, and Outcomes of Isolated Cardiac Sarcoidosis versus Extra-Cardiac Sarcoidosis With Cardiac Involvement
Authors: Chaitanya Rojulpote, Abhijit Bhattaru, Shivaraj Patil, Mahesh K Vidula, Eliot G Peyster, David S Frankel, Saman Nazarian, Harold I Litt, Lee R Goldberg, Francis E Marchlinski, Paco E Bravo
Journal: Circulation (2022)

Introduction: Diagnosing cardiac sarcoidosis (CS) remains challenging due to limitations of available clinical criteria and low yield of endomyocardial biopsy. PET-MR imaging allows for multidimensional non-invasive assessment of suspected CS. However, the true diagnostic and prognostic impact of these modalities require further exploration. Hypothesis: PET-MR can phenotype CS and its associated treatment response. Methods: We identified 100 patients with known or suspected CS (52±1.8 years, 66% male) who underwent PET-MR imaging: 38 individuals with isolated CS (ICS) (50±1.8 years, 65% male) and 62 subjects with CS and biopsy-proven extra-cardiac sarcoidosis (ECS) (52±2.4 years, 66% male). A subset of 56 patients (24 ICS and 32 ECS) was classified as the phenotype cohort if they were: 1) treatment naïve, 2) started on immunosuppressant treatment after PET, and 3) had follow up PET to assess treatment response, which was graded as complete (CTR), partial (PTR), and no response (NR). PET-MR phenotype was graded as combined imaging findings suggestive of CS (Figure 1A), equivocal for CS, and not suggestive of CS. Major adverse cardiovascular events (MACE) were defined as sustained ventricular tachycardia, ventricular fibrillation, heart transplantation and/or cardiac death at 1 year. Results: From the ICS phenotype cohort, PET-MR findings suggestive of CS were present in 100% (8/8) of patients with biopsy-proven ICS vs. 56% (9/16) of subjects without biopsy (P=0.03). CTR/PTR rates were overall higher in ECS compared to ICS (81% vs. 58%; P=0.06), and in patients with PET-MR suggestive of CS (P=0.01; Figure 1B), in both the ECS (P=0.04) and ICS (P=0.08) groups. MACE events were significantly greater in ICS vs ECS (HR 3.9 [1.6 - 9.7]; P=0.003), and in patients with PET-MR suggestive of CS (HR 8.2 [1.1 - 62]; P=0.04; Figure 1C). Conclusion: PET-MR can identify phenotypes of CS which have distinct disease manifestations, treatment response rates, and clinical outcomes.
Abstract 12337: Mortality Trends in Aortic Valve Stenosis in High-Income Countries: The Impact of Recent Advances in Procedures
Authors: Makoto Hibino, Arjun Pandey, Raj Verma, bobby yanagawa, Subodh Verma
Journal: Circulation (2022)

Introduction Aortic stenosis is a critical but addressable structural heart disease which has traditionally been treated with open surgery. Recently progress in transcatheter aortic valve replacement provides less invasive treatment option especially in elderly patients. The actual impact on death from aortic stenosis across countries remains unclear. Hypothesis We hypothesized that mortality trends from aortic stenosis would be improving in high-income countries. Methods We analyzed the WHO mortality database to determine trends in mortality from aortic stenosis in UK, Germany, France, Italy, Japan, Australia, USA, and Canada from 2000 to 2020. Crude mortality rate and age-standardized mortality rate per 100,000 persons were calculated. We calculated age-specific mortality rates in three groups (&lt;64, 65-79, and ≥80 years). Annual percentage change was analyzed using joinpoint regression. Results In the most recent year, crude mortality rates and age-standardized mortality rates from aortic stenosis ranged from 3.38 in Australia to 8.93 in Germany, and 0.93 (95%CI, 0.91, 0.96) in Japan and 2.20 (95%CI; 2.15, 2.25) in Germany, respectively and in USA, they were 4.22 and 1.65 (95%CI; 1.62, 1.68), respectively. There were trends towards increased age-standardized mortality rates during the observation period in the UK, Germany, Italy, Japan and Canada, and no significant change in France, Australia, and the USA. Decreasing age-standardized mortality rates were observed in Germany after 2012 (-1.2%, p=0.015), Australia after 2011 (-1.9%, p=0.005), and USA after 2014 (-3.1%, p&lt;0.001). In contrast to other younger age groups, favorable mortality trend change was identified in those with ≥80 years in all 8 countries. Conclusions Trends in mortality from aortic stenosis are increasing or constant in the 8 countries over the observation periods, however favorable trend changes were identified especially in age group of ≥80 years.
Abstract 12090: Catheter Ablation Impairs Left Atrial Function in Patients With Atrial Fibrillation: A Magnetic Resonance Imaging Study
Authors: Yaacoub Chahine, Fima Macheret, Lee Bockus, Joonseok Kim, Nazem W Akoum
Journal: Circulation (2022)

Introduction: Atrial fibrillation (AF) is associated with left atrial (LA) fibrosis and morphological remodeling. Catheter ablation (CA) is a well-established method of treatment for AF which results in additional LA scarring. Cardiac magnetic resonance (CMR) imaging is the gold standard for evaluating LA volumes and function, and feature tracking in CMR has been increasingly confirmed as a feasible and reproducible technique for assessing LA function through strain. We used CMR to assess baseline fibrosis, ablation-induced scarring and the impact of CA on LA volume, shape and function in patients with AF undergoing their first catheter ablation. Methods: AF patients underwent late gadolinium enhancement CMR prior to, then at least 3 months after CA for quantification of LA volumes, fibrosis and ablation-induced scarring, respectively (Panel A). Global longitudinal reservoir strain (GLRS) was assessed by feature tracking (Panel B). Cine-images were used to assess sphericity and emptying fraction. All CMR images were obtained in sinus rhythm. Wilcoxon signed rank analysis was used to assess the effect of CA on LA volume and sphericity index, emptying fraction and GLRS. Results: 40 patients (57% male, average age 61.9 years, 72.5% paroxysmal AF) were included. Pre-ablation LA fibrosis was 16.6% [9.1, 20.7] whereas ablation-induced LA scar was 8.0% [6.5, 12.1]. GLRS and LA emptying fraction decreased after CA (17.8 [15.3, 20.5] vs 16.0 [13.5, 19.0] p=0.006, and 60.2% [51.3, 66.4] vs 51.6% [46.3, 61.1], p&lt;0.001, respectively). However, LA volume index and sphericity index were unchanged after CA in our study cohort (48.0 mL/m 2 [37.1, 61.1] vs 47.0 mL/m 2 [36.2, 52.7] p=0.91 and 54.6% [47.2, 65.4] vs 53.2% [46.5, 64.5] p=0.8, respectively) (Panel C). Conclusion: LA function is negatively impacted by catheter ablation for AF. The competing impact of ablation on rhythm control and atrial function with respect to stroke and heart failure need to be further evaluated.
Abstract 11665: Mediation of Sterile Inflammation Through Ca <sup>2+</sup> / Calmodulin-Dependent Protein Kinase in Macrophage is Essential for Pressure Overload-Induced Adverse Cardiac Remodeling
Authors: Takeshi Suetomi, Satomi Tateda, Yoko Okamoto, Hitoshi Uchinoumi, Tetsuro Oda, Shigeki Kobayashi, Takeshi Yamamoto, Masafumi Yano
Journal: Circulation (2022)

Introduction: There is evidence that inflammation is associated with pressure overload induced cardiac remodeling and heart failure, as well as evidence for a role of Ca 2+ / Calmodulin-dependent protein kinase II (CaMKII) in remodeling and heart failure development. Pressure overload triggers inflammatory gene expression and the activation of the NOD-like receptor pyrin domain containing protein 3 (NLRP3) inflammasome in cardiomyocytes. These responses provide signals for macrophage recruitment, fibrosis, and myocardial dysfunction in the heart. However, the downstream mechanism is not elucidated. Methods and Results: Macrophage specific CaMKIIdelta knockout (mKO) mice were subjected to transverse aortic constriction (TAC). Cardiomyocyte mRNA levels for pro-inflammatory chemokines and cytokines increased and peaked with 5 to 10 folds vs sham in both control and mKO mice. Priming and activation of the NLRP3 inflammasome, assessed by measuring NLRP3 mRNA and caspase-1 activity, were increased by TAC in isolated cardiomyocytes of both control and mKO. In contrast, caspase-1 activation in isolated macrophage were attenuated in mKO. CD68 positive cell accumulation and cardiac fibrosis in cardiac tissue in response to pressure overload were also attenuated in mKO vs control (CD68 41 ± 9 cells/mm 2 vs 78 ± 13 cells/mm 2 , fibrotic area 8.5 ± 1.2 % vs 4.1 ± 0.9 %). Subsequent cardiac dysfunction in response to pressure overload were less impaired in the mKO vs control (ejection fraction 44 ± 3% vs 35 ± 6%). Conclusions: Activated CaMKIIdelta in response to pressure overload triggers inflammatory signals including NLRP3 inflammasome cascade in cardiomyocytes. It also contributes amplification of inflammasome signal in macrophages leading fibrosis and consequent cardiac dysfunction. CaMKIIdelta in cardiomyocytes and macrophages could be a therapeutic anti-inflammatory and anti-fibrotic target for preventing adverse cardiac remodeling and heart failure.
Abstract 12362: Increased Cardiovascular Mortality Rates Within Historically Redlined Neighborhoods
Authors: Elise Dilci, Demir Dilci, Vivian Ho, Biykem Bozkurt
Journal: Circulation (2022)

Introduction: Redlining maps were developed by the Home Owners’ Loan Corporation (HOLC) in 1933 to depict perceived level of risk in home loans with ratings of best”, “still desirable”, “declining”, and “hazardous”. Neighborhoods that were “all-white” were rated as “best”, colored green, whereas Black neighborhoods were automatically assigned “hazardous” investment and colored in red, hence the term “redlining”. (Figure 1A) Living in historically redlined areas has been associated with disparities and adverse outcomes; however, their association with cardiovascular mortality rates has not been described. We sought to compare the cardiovascular mortality rates in historically redlined neighborhoods with others in Houston, Texas. Methods: Demographics and cardiovascular mortality rates reported by Department of Health and Human Services between 1999-2003 were compared between historically redlined neighborhoods and neighborhoods outside the limits of the HOLC maps in Houston, Texas. Results: Super-neighborhoods within historically redlined zones categorized as “hazardous” when compared with neighborhoods not in HOLC map zones, had a significantly higher proportion of Black residents (41.4 vs 21.1%, p=0.01), a higher proportion of residents with income less than twice the poverty level (28.1 vs 21.6%, p=0.04), significantly higher age adjusted mortality rates per 100,000 population for heart disease (304.65 vs 254.3, p=0.01), stroke ( 92.2 vs 70.5, p=0.001) and coronary heart disease (196.9 vs 164.4,p=0.01), and significantly higher years of potential life lost due to heart disease (905.6 vs 681 age-adjusted annual years of life lost per 100,000 population for &lt;age of 65;p=0.03). (Table and Figures 1B &amp;C) Conclusions: Living in historically redlined areas is associated with increased cardiovascular mortality rates. Future research should examine strategies to improve cardiovascular health in historically redlined neighborhoods.
Abstract 12625: Genome-Wide Analysis Revealed Genetic Control of the Renin-Angiotensin-Aldosterone System in the General Population
Authors: Maeregu Woldeyes Arisido, Luisa Foco, Eva König, Maria-Christina Zennaro, Marko Poglitsch, Peter P Pramstaller, Christian Fuchsberger, Cristian Pattaro
Journal: Circulation (2022)

Introduction: The Renin-Angiotensin Aldosterone system (RAAS) is the major player in the long-term blood pressure (BP) regulation. The RAAS is targeted by commonly used anti-hypertensive drugs, but despite its importance, little is still known about its genetics, partially due to the technical difficulties in the quantification of the involved biomarkers. Methods: Using mass-spectrometry, we simultaneously quantified in serum equilibrium angiotensin I, angiotensin II and aldosterone on 2105 participants to the Cooperative Health Research In South Tyrol study (CHRIS), who were either normotensive or under documented anti-hypertensive drug (AHD) treatment. We derived proxies of renin activity (PRA-S= angiotensin I + angiotensin II), angiotensin-converting enzyme activity (ACE-S= angiotensin I / angiotensin II) and adrenal gland function (AA2-ratio =aldosterone/ angiotensin II). We tested association of these biomarkers with 1,085,897 SNPs imputed against a population specific whole-exome-sequencing-based panel, adjusting for age, sex, AHD, and assuming an additive genetic model using Regenie v3.1.1. Results: Study participants were 21 to 95 years old, and 52% were females. Most participants (86%) received specific AHD treatments. ACE-S was associated with variants spanning the ACE gene. The top association was seen at rs4363 (p=2.8E-18), already associated with serum ACE level, and replicating previous findings in an Asian population sample. We found strong evidence of association of angiotensin II and AA2-ratio with the stop gained rs27044 (p=8.2E-10) in the ERAP1, involved in angiotensin II degradation. We observed a borderline association between aldosterone and the synonymous rs7275 at SMARCA4/LDLR (p=5.85E-8), previously related to lipid metabolism. We also report a novel suggestive association between angiotensin I and rs2274978 in the Xaa-Pro aminopeptidase I (XPNPEP1; p=9.49E-6). Conclusions: While some results await replication in an independent cohort, findings are consistent with known physiology, and shed light on genetic background of BP regulation.
Abstract 13945: Patients Admitted With Type 2 Acute Myocardial Infarction Without Standard Modifiable Risk Factors Have Worse Outcomes Compared to Patients With Standard Modifiable Risk Factors
Authors: Balamrit Singh Sokhal, Andrija Matetic, Timir K Paul, Poonam Velagapudi, Ekaterini Lambrinou, Gemma A Figtree, Muhammad Rashid, Saadiq Moledina, Vassilios Vassiliou, Christian D Mallen, Mamas Mamas
Journal: Circulation (2022)

Introduction: Patients without standard modifiable cardiovascular risk factors (SMuRF; hypertension, diabetes, hypercholesterolaemia, smoking) have worse outcomes in Type 1 acute myocardial infarction (AMI). The relationship between type 2 AMI (T2AMI) and outcomes in patients with and without SMuRF is unknown. This study aimed to determine the prevalence, characteristics and clinical outcomes of patients hospitalized with T2AMI based on the presence of SMuRF. Methods: All hospitalizations with a primary discharge diagnosis of T2AMI in the National Inpatient Sample were stratified according to SMuRF status (SMuRF and SMURF-less). Primary outcome was all-cause mortality while secondary outcomes were major adverse cardiovascular and cerebrovascular events (MACCE), major bleeding and ischemic stroke. Multivariable logistic regression was used to determine adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). Results: Among 17,595 included hospitalizations, 1,345 (7.6%) were SMuRF-less. After multivariable adjustment, SMuRF-less patients were more likely to develop all-cause mortality (aOR 2.43, 95% CI 1.83 to 3.23), MACCE (aOR 2.32, 95% CI 1.79 to 2.90) and ischaemic stroke (aOR 2.57, 95% CI 1.56 to 4.24) compared to their SMuRF counterparts ( Figure 1 ). Conclusions: T2AMI in the absence of SMuRF was associated with worse in-hospital outcomes compared to SMuRF-less patients. Further longitudinal studies are necessary to define the impact of SMuRF on longer term T2AMI outcomes.
Abstract 13016: Tumor or Thrombus?: Intracardiac Thrombus Masquerading as a Tumor
Authors: Ashwin Mahesh, Manish Kumar, Joyce Meng
Journal: Circulation (2022)

Introduction: Intracardiac masses comprise thrombi, vegetations, and tumors. Multimodality imaging modalities are often relied upon for a definitive diagnosis. We present a case of a left ventricular (LV) thrombus with characteristic of on contrast echocardiography that thrombus based on cardiac MRI. The mass resolved with anticoagulation. Case: A 56-year-old male with non-ischemic cardiomyopathy was admitted for management of decompensated heart failure. Transthoracic echocardiography (TTE) showed reduced left ventricular ejection fraction of 20 to 25% with diffuse hypokinesis. There was a newly detected large intracardiac mass seen in the left ventricle (figures 1-3) that enhanced with echocardiographic contrast (figure 2). Delay enhancement imaging on cardiac MRI, however, revealed a hypodense mass suggestive of a thrombus (figure 3). The patient started anticoagulation. An echocardiogram performed a month later revealed complete resolution of mass, confirming the thrombotic nature of mass (figure). Discussion: Contrast enhancement echocardiography is very helpful for characterization of intra-cardiac masses. Tumors usually enhance with contrast while thrombi are generally dark. Our case is unusual, the cardiac mass hyper-enhanced with echocardiographic contrast but had thrombus-like characteristics on cardiac MRI. The mass was proven to be a thrombus over time since it resolved with anticoagulation. Echocardiographic contrast usually fails to penetrate hard, chronic thrombi. However loosely structured, fresh thrombi may allow some passage of contrast. This has been demonstrated in carefully conducted in-vitro studies showing that imaging characteristics of newly formed thrombus is often bright with echocardiographic contrast. This underscores the importance of multi-modality imaging to diagnose the nature of a cardiac mass.
Abstract 13534: Trends, Predictors, and Outcomes of Maternal Shock From the National Inpatient Sample 2009-2019
Authors: Fawzi Zghyer, Ahmed Daniyaal Rasheed, Harsh P Patel, Yaa A Kwapong, Ellen Boakye, Sourbha Dani, Roger Blumenthal, Garima Sharma
Journal: Circulation (2022)

Introduction: Maternal shock is an important contributor to severe maternal morbidity and mortality. Although there is some data on hypovolemic shock in pregnancy, the literature on maternal shock is remarkably limited. Methods: Data from the National Inpatient Sample with delivery hospitalizations from 2009 to 2019 were used for the data extraction. Diagnosis codes from the International Classiﬁcation of Diseases, 9 th and 10th Revision for common cardiovascular disease (CVD) conditions, adverse pregnancy and fetal outcomes, and delivery complications including shock, were used. Multivariable logistic regression was performed to assess the predictors and outcomes associated with maternal shock. Results: A total of 41,573,217 delivery hospitalizations were analyzed, of which 13,217 were complicated by maternal shock. The trend of maternal shock was seen to rise from 20 to 45 per 100,000 hospitalizations over the study period (Fig 1A). Traditional cardiovascular risk factors and diseases (e.g., hypertension and heart failure) were significant predictors of maternal shock(Fig 1B). The presence of coagulopathy (Odds Ratio [OR]: 16.2, 95% CI: 15.4-17.0) and peripheral arterial disease (OR: 6.4, 95% CI: 4.9-8.2) were strong predictors of maternal shock. All-cause in-hospital mortality (3.82%), pre-eclampsia (10.78%) and cardiac arrest (5.69%), (all p &lt;0.001), were adverse outcomes that were significantly associated with maternal shock. Conclusions: Overall, the trend of maternal shock was seen to increase more than 2-fold per 100,000 hospitalizations over the 10-year study period. Patients hospitalized for delivery with co-morbid CVD conditions such as heart failure, coagulopathy, and peripheral arterial disease are at an increased risk of developing maternal shock and must be monitored more closely. Subsequent research should focus on characterizing the types of shock and treatment strategies in this population.
Abstract 11183: Unusual Color Flow Leads to Diagnosis of Unroofed Coronary Atrial Septal Defect
Authors: Andrew Mehlman, Sean Swearingen, Laith Derbas, Priya Patel, Nada Shaban
Journal: Circulation (2022)

Introduction: Unroofed coronary sinus-atrial septal defect (CS-ASD) is a very rare anomaly that may be easily missed by transthoracic echocardiography. Case: A 59 year old woman presented with chronic and progressively worsening dyspnea. TTE demonstrated preserved ejection fraction, right ventricular and atrial dilation, and elevated pulmonary artery pressures. Color doppler demonstrated a persistent diastolic flow at the interatrial septum immediately above the plane of the tricuspid valve, suspicious for atrial septal defect (Fig. 1). Such aberrant flow was not observed on multiple prior TTEs. Decision-Making: Given the uncertain nature of the abnormal color flow seen, further imaging was pursued with a gated Cardiac CT with contrast. CT imaging demonstrated a dilated coronary sinus with a communication between the roof of the terminal coronary sinus and the left atrium, consistent with an unroofed coronary sinus-atrial septal defect (CS-ASD) (Fig. 2). There was no evidence of a persistent left superior vena cava. Cardiac MRI demonstrated a significant right to left shunt with a Qp/Qs of 1.53 using phase contrast imaging. Discussion: CS-ASD is a very rare cardiac anomaly and is the most uncommon type of ASD (&lt;1%), often associated with a persistent left superior vena cava. Given the posterior nature of the defect, it is often missed on TTE. In our case, suspicion was raised by a small abnormal color jet of flow coming from the interatrial septum. Cardiac CT is an excellent diagnostic modality for CS-ASD given its excellent visuospatial capabilities and ability to evaluate pulmonary veins. Cardiac MRI may serve as a helpful adjunct in quantification of shunt flow.
Abstract 11964: Implementation of a Near Peer ECG Didactic Curriculum in an Internal Medicine Residency Program
Authors: Matthew G Kaye, Hassan A Khan, Yan Yatsynovich, Gregory D Gudleski, Susan P Graham, Alysia Kwiatkowski
Journal: Circulation (2022)

Introduction: Electrocardiogram (ECG) interpretation is a fundamental skill. Near-peer teaching improves knowledge acquisition and learner satisfaction. We previously demonstrated an improvement in resident comfort level in interpreting ECGs following structured didactics. Here, we aim to establish whether a longitudinal didactic curriculum objectively increases resident performance in ECG interpretation. Methods: This prospective cohort study surveyed Internal Medicine residents at University at Buffalo who participated in monthly ECG didactics over a 7-month period. Pre- and post-curriculum surveys were administered. Responses were anonymous and participation voluntary. Data collected included demographics, attendance, exposure to clinical cardiology, interest in cardiology, and number of sessions attended. Residents were asked to interpret sixteen unique ECGs, divided evenly among eight common rhythms into both surveys. Fall 2021 and Spring 2022 cohorts were compared using t-tests and chi-square analyses. Associations between attendance, comfort level in interpretation, and number of correct interpretations were analyzed using Pearson correlations. Multivariate linear regression determined the strongest predictor of the number of correct ECG interpretations. Results: Spring cohort correctly interpreted a significantly greater percentage of ECGs than Fall cohort (74.5% vs. 60.9% , p &lt; 0.001). Didactic attendance was significantly associated with comfort level in interpreting ECGs (r = .328, p = .018) and a showed trend towards increased number of correct interpretations (r = .248, p = .077). Attending three or more sessions resulted in a greater percentage of correct ECG interpretations compared to those who attended two or fewer sessions (80.0% vs. 71.1%, p = 0.48). Number of clinical cardiology blocks taken was significantly associated with correct interpretations (r = .310, p &lt; .001) and was the strongest predictor of accurately interpreting ECGs (β = 0.29, p = .037). Conclusions: Dedicated ECG didactics improve residents’ ability to interpret ECGs. A longitudinal curriculum which contains both didactic sessions and clinical exposure appears to offer the greatest benefit in improving ECG interpretation skills.